Extensive peritumoral brain edema in a small clinoidal meningioma: clinical case

Abstract

Peritumoral brain edema (PTBE) is seen in 40-78% of all cases of intracranial meningiomas. It may vary in shape and size, occasionally being two to three times larger than the tumor. We present a case of a 62-year-old female patient, suffering from seizure and progressive headache. She was diagnosed with left medial sphenoid wing meningioma and referred for treatment to Uzhhorod Regional Center of Neurosurgery and Neurology. The patient had no major focal neurological deficit and Karnofsky Performance Scale (KPS) of 70 on admission. The preoperative magnetic resonance imaging (MRI) with and without contrast showed a 2.1×2.2×2.5 cm solid mass at the inner third of the left sphenoid wing, with homogenous enhancement and encasement of middle cerebral artery (MCA). In addition, there was a disproportionately extensive PTBE in the left cerebral hemisphere that caused midline shift and mass effect. The patient underwent left pterional craniotomy and gross total resection of the mass. The postoperative course was without complications or new neurological deficit, MRI within 48 hours revealed gross total tumour resection with residual brain edema and the patient was discharged with a KPS of 80 on day 7. Based on several studies, significant correlation between PTBE and tumor volume was observed: larger tumors cause larger PTBE. This particular case had a very large hemispheric PTBE, which was disproportionate to the small size of the meningioma. Most likely, the PTBE in this patient was caused by venous congestion, but this had no influence on surgical outcome. Therefore, the presence of a large PTBE does not necessarily indicate a poor prognosis and isn’t always the reason of surgical complications.